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Plan To Fluoridate Cook Islands Water Brings Controversy

RAROTONGA, Cook Islands (Cook Islands News, Jan. 3, 2015) – On average, every five-year-old in the Cook Islands has a smile with at least six decaying teeth.

The huge cost associated with this oral health epidemic is not known, but one cannot put a price on the importance of dental care for future generations. The issue of putting fluoride in the public water supply has caused controversy amongst the community. However with completion of the Te Mato Vai project looming, Phillipa Webb investigates the benefits of this public health measure...

For Cook Islands Ministry of Health chief dental officer Danny Areai, there is no question: If this country is going to successfully combat a growing tooth decay problem, we need fluoride in our water supply.

In his report, ‘Water Fluoridation in Rarotonga - why we should do it’, Areai lists a number of reasons why fluoride should be added to our water supply.

He says the issue has come to light for the first time in Cook Islands history, mostly as a result of the upgrade of Rarotonga’s water supply system that began with the launch of the Te Mato Vai project last year. When the project is complete, it will be possible to add both fluoride and chlorine to the public water supply.

"Our existing water supply does not have the capability to allow us to add fluoride to it, hence our experience with water fluoridation is quite limited," says Areai.

An advocate of water fluoridation as a population-based method for reducing tooth decay, he says it has been successfully adopted in many parts of the world and has been shown to reduce dental decay by up to 60 per cent.

"The decline in dental decay in many parts of the world has been attributed to water fluoridation - in fact water fluoridation has been reported as one of the top 10 public health measures of the past century."

Despite this, water fluoridation has been met with resistance from anti-fluoride groups who claim fluoride can be damaging to peoples’ health as it is toxic, he says. CINews has even printed letters from readers who call fluoride the "white man’s poison".

But Areai says evidence shows that the benefits of fluoride outweigh its perceived negative effects.

"Perhaps, some may ask why fluoridate the entire water system when it is only dental decay (we want to target)?

"One of the major advantages of water fluoridation is the ability to reach the wider community. This is particularly important for those most vulnerable groups in the community."

The pain and suffering associated with dental decay has far-reaching consequences as it can adversely affect peoples’ ability to perform important functions such as eating or smiling, talking and socialising with others, he says.

"Dental pain can also affect children’s ability to learn, as often they will be out of the classroom to receive treatment, thus missing out on school time."

In the Cook Islands, tooth decay is prevalent among both young children and the adult population, he says.

A survey has shown that five-year-old children in the Cook Islands each have an average of six decaying teeth. And decaying teeth can mean a lifetime of dental struggles: fillings, painful extractions, and even the need to fit dentures.

The issue certainly polarises peoples’ opinions and many oppose fluoridation, no matter what. But there is compelling evidence that they’re wrong.

The Royal Society of New Zealand and Department of the Prime Minister’s chief science advisor, Sir Peter Gluckman, produced a report in August this year titled, ‘Health Effects of Water Fluoridation: A Review of the Scientific Evidence.’

"There is compelling evidence that fluoridation of water at the established and recommended levels produces broad benefits for the dental health of New Zealanders," the report says.

"In this context it is worth noting that dental health remains a major issue for much of the New Zealand population, and that economically and from the equity perspective, fluoridation remains the safest and most appropriate approach for promoting dental public health."

The only side effect of fluoridation at levels used in New Zealand is minimal fluorosis (mottling of the tooth enamel), and this is not of major cosmetic significance, the report adds.

"There are no reported cases of disfiguring fluorosis associated with levels used for fluoridating water supplies in New Zealand."

The use of fluoridated toothpastes does not change these conclusions or counter the recommendations, Gluckman says.

This is because fluoride is known to have a protective effect against tooth decay by preventing demineralisation of tooth enamel during attack by acid-producing plaque bacteria.

In infants and young children, ingested fluoride is incorporated into the developing enamel, making teeth more resistant to decay.

Drinking fluoridated water or brushing teeth with fluoride toothpaste raises the concentration of fluoride in saliva and plaque fluid, reducing the rate of enamel demineralisation during the tooth decay process and aids remineralisation of the lesions which are often the first visual indication of tooth decay.

When ingested in water, fluoride is absorbed and secreted back into saliva, where it can again act to inhibit enamel demineralisation.

A constant, low level of fluoride in the mouth has also been shown to combat the effects of plaque bacteria, which are fuelled by dietary sugars.

Despite the health benefits it could provide, the future of water fluoridation in the Cook Islands is unclear.

The $64 million Te Mato Vai project to restore Rarotonga’s water mains has looked at the possibility of both chlorinating and fluoridating the water.A Te Mato Vai spokesperson says fluoride will remain a matter for community consultation that will require education of its benefits. It will also require public acceptance, which may prove to be a more thorny issue.

The Te Mato Vai project team will work closely with the Ministry of Health as consultations on the issue take place next year.

But Areai says first, better education and community awareness of the benefits of fluoridating the water supply are required. He says the root source of many of the dental problems in this country also need to be looked at.

"Diet must be addressed – sugar is the biggest factor that causes tooth decay."

The cheapness and wide availability of sugar-filled soft drinks has been identified as a problem, but whether enough has been done to combat the issue is unclear, he says.

Nevertheless, an effective way to combat tooth decay remains the fluoridation of water, ensuring the smiles of Cook Islanders always shine bright.

Pacific Islands Report is a nonprofit news publication of the Pacific Islands Development Program at the East-West Center in Honolulu, Hawai‘i. Offered as a free service to readers, PIR provides an edited digest of news, commentary and analysis from across the Pacific Islands region, Monday - Friday.